I think people are being a little too hard on the author. Startups in healthcare are hard. Been there, done that, have the t-shirt (literally, that's all that left). I even made the same fatal mistake - not identifying who the buyer really is. And when I say identifying the buyer, I don't mean it in that hand-wavey, vague way like "doctors" or "insurance companies". The starting point has to be something like "ophthalmologists in small practices (1-10 doctors) in New England who are trying to acquire new patients through social media."
And here's something that's absolutely critical for all engineers trying to build a startup in healthcare to really understand. Healthcare is so alluring because tech people are so idealistic. We think, "Wow, we we can write some code, and then save lives!" And that's sometimes true. But when you are thinking of your customer, revenue model, sales strategy - all that business stuff - the mistake we make is thinking healthcare is different and the same rules don't apply. We think if we can save lives, we can make a business. But the key insight is that you have to take a step back and just treat healthcare like any other for-profit business. Doctors and hospitals care about what generates revenue. Insurance companies want to save money. Pharma companies are looking to advertise to new customers. It's no different than other industries. The psychiatrist's reaction to the sales pitch is the classic thing a doctor will tell when you're not helping their bottom line. As I was reading the post, I could almost predict how she was going to respond.
And if you figure that business stuff out, who knows, you might just build a healthcare business that saves a life or two.
From a business standpoint, saving lives can actually be expensive. The longer someone lives, the more healthcare they consume.
Health insurance companies are very aware of this, which is why they so frequently deny coverage for various life-saving cancer treatments. If you die while waiting for treatment, not only do they save the cost of the treatment, but also the entire cost of ongoing screening / care during remission.
> But the key insight is that you have to take a step back and just treat healthcare like any other for-profit business. Doctors and hospitals care about what generates revenue. Insurance companies want to save money. Pharma companies are looking to advertise to new customers. It's no different than other industries.
This is one of the most concise and effective arguments I have read for Medicare-For-All, Single Payer, etc.
At risk of identifying myself, I work in this industry (or should I say, I work in the medical field) and yes... it's insane. And of course, you get that privileged peak behind the veil, you get to see how the sausage is made as it were.
It is truly humbling because there is no easy solution, there are no unified APIs; you couldn't use them even if there were, because your medical records are highly sensitive. So forget about poking around production to solve a bug, you've got to do it through observability.
You can't move fast and break things because your downtime will get the regulators involved, because peoples livelihoods are at stake. You will get official complaints through various official bodies who can and will sanction the business.
In short, it's not a fucking joke and it takes a lot more time and a lot more money to do something serious here, and for good reason.
Note that I'm not talking about low-key wearables like Fitbits that monitor your pulse, I'm talking about doctors, triage, etc.
>I think people are being a little too hard on the author. Startups in healthcare are hard.
They are hard, but this case isn't really healthcare-related. He tried pitching his product to practices without showing how it could increase their revenue, or decrease their costs. Without that, his product is just another cost-center with some marginal (and ambiguous) healthcare benefits.
This. Been through two medical device companies that pivoted from clinical trials to product and the major hardships came from not fully understanding the money trail. In the UK the 'Cathedral' of the NHS means that the benefits may not be felt by the your customer.
I still think this idea is powerful. Not because I believe it transforms healthcare, but because it informs consumers a bit more. That’s what seemed to get you excited in the first place.
There are a few paths I see still:
a. Assuming you own a database, expose your dataset as an API. Consider possible consumers. Open source it, and monitor the usage. Who’s using that data.
b. Cold message a few folks on Linkedin from pharmaceuticals that your algo says has high clinical success. Can you “recommend” them? Do they see value. Maybe you have a research tool on your hands.
3. If you can keep your website alive, focus on SEO and gain traction with more users and play that out. Write blog posts, use affiliate marketing, and grow users. But don’t add new features. Just maintain what you have. Try that for a year at least. What did you learn?
I think the toughest thing here is knowing when to stop building the product. That’s what stands out to me as your demise.
The doctor was spot on, and those are the kinds of things you want to hear. It just means looks somewhere else. Writing a doc beforehand with potential opportunities is always a good idea, but it’s never too late.
Disclaimer: I do product at MEGACORP and love product strategy.
This is a classic case of "it's not a product, it's a feature". This is true of almost everything in healthcare that's software-related: it's only useful if it's integrated with the EMR. This is why you never see software startups in healthcare.
In this case, similar functionality (drug recommendations) exist within EMR systems. Except the recommendations are issued by other doctors and medical researchers, not some ML algorithm and it works transparently with the pharmacy management modules.
Moral of the story: don't get involved with healthcare startups unless you know the structure and economics of the industry. They are very different from consumer / business tech.
I was thinking the same, except OP's product seems more like a feature for an EMR platform and less a standalone product.
The only downside is that sharing this information may open up the hospital to more liability - i.e. a patient takes an opiate instead of an NSAID and then blames the hospital for recommending the opiate to them because of how much more effective the opiate is at treating pain in clinical trials.
Maybe you could open source it, and with the help of people from the community get sort of grant from Google or Amazon or say digital ocean so that this could work without you having to pay for servers? All the work that contractors were doing, people could do that for free. The only thing is I’d license this thing so that it can’t be used commercially (except for research)
Another possibility: how many people would be willing to donate a few bucks a month to support it? Call it the public radio model. You won't get rich, but you might pay for upkeep and servers.
I'm so confused by the tone of this article. Obviously some of the jokes are parodying startup culture and are meant to be funny, however I think the "fantastic idea" stuff is meant seriously?
"So I built something people wanted. Consumers wanted it, doctors wanted it, I wanted it. Where did I go wrong?"
As far as I can tell, nobody wanted it except the author. The one doctor he talked to didn't, and no consumer ever saw it. I feel like the author learned a lesson, but not the full lesson.
Reading this was like watching someone you don't politically agree with doing comedy. You know they're trying to be funny, but you also know they're missing the whole point and aren't self-aware.
The funny part is, he might still be wrong about it being worthless. He talked to ten doctors? There are 1M in the US. It's kind of funny to drop all that time and 40k in then give up after ten doctors say no, especially without trying to tweak the product based on feedback.
I, as a consumer, find it worthless and they shouldn't have even started it, but now that you're here, might as well give it a bit more of shot than that. To completely bail on what you have after 10 no's is also the wrong move.
Doesn't seem like he asked the question, "well, what would you pay for?"
> Reading this was like watching someone you don't politically agree with doing comedy. You know they're trying to be funny, but you also know they're missing the whole point and aren't self-aware.
are you not supposed to laugh at the jokes of someone you disagree with politically? is it possible someone could be "self-aware" and still disagree with you?
I take the article to be written in the mindset he had at the time. When he made that quote you mentioned, he thought as he was heads-down building the product that it would be useful to those people.
He then goes on to describe the evidence specifically why doctor's DIDN'T want it. All the author was trying to do with that quote was explain what he was thinking at the time.
Ya, I'm surprised it's not just a static landing page for consumers with ads. At .50 cents per user, that's only 80k users required to break even (ignoring the time variable there)
The first example the author gave with painkillers is inherently bad.
Sure, Aleve is the most powerful. But it also has the most side effects, including ulcers if used for too long. There's a lot of nuanced information when it comes to drugs. If you want to go on pain killers like Aleve for long term, you probably need to take acid blockers as well, like Nexium. So where does that fall into the analysis?
Unfortunately a lot of stuff requires medical doctors that have experience. I just went through a severe health emergency, where I was taking one antibiotic and needed to be changed to another. I needed blood tests and constant supervision for the doctor to make this decision.
Psychiatry, which is what I guess the author targeted, is likely even less reliable. My friend is a pharmacist and was on anti-anxiety medication for a year, but decided to try another one, because of the effects on her were affecting her and now she's doing much better. This requires working with a psychiatrist for a year.
I think there's value in surfacing all this information but to expect people to rush into paying for it is naive. It's a nice-to-have-tool that might be useful like a Google-type research tool but nothing someone would want to pay $5/month for since the actual benefit over a psychiatrist just going off experience is completely unknown. There no inherent home run here.
>Sure, Aleve is the most powerful. But it also has the most side effects, including ulcers if used for too long. There's a lot of nuanced information when it comes to drugs. If you want to go on pain killers like Aleve for long term, you probably need to take acid blockers as well, like Nexium. So where does that fall into the analysis?
Am I wrong or isn't solving these issues basically the service UpToDate offers?
I wish he could have invested more in the idea - I think it's an amazing concept but the creator pulled the plug too early. Sales cycles in B2B can take months, and in healthcare they can take years.
Especially the doctor's feedback, she described the possibility of changing her habits slowly as she got used to using the tool.
Unrelated:
"I always have the best interests of my patients in mind, but, you know, it’s not like they’ll pay more if I prescribe Lexapro instead of Zoloft. They won’t come back more often or refer more friends. So I’d sorta just be, like, donating this money if I paid you for this thing, right?”
This line kills me and it's exactly why I hate the healthcare industry. She clearly understands that the software could improve patient outcomes, but describes it as a donation and still wouldn't change how she writes prescriptions (out of laziness, I guess?)
Sounds like there's an opportunity to have insurance companies pay for the product. This would directly align incentives and lead to overall cheaper care for the patients.
That anecdotal interaction is extremely damning for the entire US healthcare system. Physician admits she prioritizes practice revenues over patient outcomes. Other physicians express similar preference. Inventor of useful tool tosses it into the mothballs.
That tool isn't just a physician aid. If that's what doctors are really doing, it's more like a physician replacement. If they won't do evidence-based medicine, and prefer to be legal drug dealers, for profitability reasons, we should all be contributing to the creation of the auto-doc, instead of trying to help them.
That $40k would have been better spent lobbying to remove the guild protections from the practice of medicine.
If all general-practice docs do is take height, weight, pulse, BP, blood oxidation, and run a CBC with lipid panel before prescribing your drugs for the year, that doesn't seem like something only an MD or NP could do. But by law, if you want prescription-only medicines, you have to go to a prescription-drug dealer and pay them for the scrip, before going to pay someone else, again, for the actual drug.
And if they're not actually doing (what I perceive to be) their jobs? If they're just "phoning it in" to collect a paycheck? That's one job I'd love to automate out of existence.
I agree with you, but at least she was honest. Many others would say no for the same reason, but wouldn't be honest about it. A prospect who is honest about their true reasons for saying no is extremely valuable when you're pitching an early product.
I think in general, if you're building a business, expecting anyone to do something that isn't in their own selfish interest in some way is a recipe for failure, even if people in your target market might claim not to have selfish motivations. If you want someone to change their behavior (and/or their organization's behavior), you need to be able to clearly explain why it's a win for that specific person.
Congratulations on learning the hardest lesson, your next startup is now a lot more likely to succeed, so get to work!
A lot of comments criticizing what the author already knows, that the business plan was incomplete. I had the urge to do the same, but read to the very end and realized TJC clearly learned the most important lesson, and it's one I've learned myself, so I have no room to be critical.
BTW, I burned a lot more than $40k and 9 months in my own story, so maybe it helps to hear that other people have made the same mistake and gotten too convinced their idea is valuable without checking carefully enough -- without quite knowing how to check carefully. I know what it feels like to know that I'm doing the right thing, and then find out that it's not good enough.
Fun read, and an important lesson that many very bright people will still learn the hard way, even after reading a story like this. Thank you for sharing.
Realistically, while I feel that the author is on the right track with this data driven approach to evidence based medicine, the fact remains that the advantages/disadvantages between drugs within the same class of medicine tend to be negligible compared to drug costs. There are then other specific concerns that must be considered eg pregnancy/breastfeeding, liver failure, kidney failure and often what ends up is that one defaults to a standard drug per drug class with alternatives in specific circumstances.
The real benefit IMO would be marketing this to countries with a top down healthcare purchasing system (eg the UK) or as a tool to drug companies/researchers looking to make their own meta analyses (eg abstrackr). It might also be better instead to diversify into correlating symptom clusters with diseases because then the utility to the end user is bigger.
Sell this product to insurance companies so they can recommend cheaper/safer drugs to their customers, or show the more expensive one and if it truly had better outcomes. Everyone benefits from that.
That said, the medical establishment is a tough tough domain to move.
The author says that they fired the contractors and closed the site. I can never relate to this. You built something that is at least somewhat useful to at least some people. Why not just keep it online forever? It can't cost more than $5/mo to host this, I have a server where I host around ten of my projects for less than $20/mo.
Why do people shut things down instead of just leaving them there, unmaintained? Even that is better than just taking it offline.
I have a family member who worked somewhere that provided tools to medical practitioners to help them determine how a patient would respond to a drug based on their genetics. They also had a hard time selling directly to clinicians, because as the author notes, they do not particularly care about patient outcomes in the abstract sense, because much like the programmer bravado, doctors have a similar one: most of the other doctors are worse than me, they need the tools but I don’t because I have a more nuanced view, I know what works for my patients better than any statistical study could tell me, etc.
The only way to make money is to get insurers to require these things, or to sell to some big hospital network administrator who you can focus your sales efforts on. I don’t think the product here was mature enough to sign a multimillion dollar contract with a hospital network, and maybe not for insurers either.
> Make something people want. It’s Y-Combinator’s motto and a maxim of aspiring internet entrepreneurs. The idea is that if you build something truly awesome, you’ll figure out a way to make some money off of it.
Nice narrative style and congratulations on achieving your (first?) failure without too much trauma.
It's possible you invested your own money prematurely, possibly without talking to enough people about the opportunity. Your metric for how much people want something is usually directly tied to revenue, or if you are using engagement as your metric, you should have figured out some way to make money off of it before you invested in development. I suggest that other engineering-minded founders think of sales like writing "hello world" -- for example, if you're doing a physical consumer product, you can start by shipping pet rocks on day one.
More than just identifying a product people want, you also want to find a network effect or viral marketing approach so you can grow with a sustainable advantage.
I think the original poster made the same mistake I did, and took the wrong lesson from the situation.
The startup idea sounds great and I would enthusiastically start working on it right now as a cofounder.
The problem was spending money before having a sense of how to get more.
That’s all.
If the startup could have been run entirely without paying contractors or incurring other serious expenses, the poster could have run it for longer, and iterated on models longer, until the product/market fit got dialed in.
There just wasn’t enough runway, enough iteration.
Oof. The site was practically named after WebMD, and the founder didn't do any market research on that competitor to gauge how viable the business was before quitting their job? This person probably should have known that their main competitor made $0.50/user before they quit their job. Also:
>It had been a bit of a working assumption of mine over the past few weeks that if you could improve the health of the patients then, you know, the doctors or the hospitals or whatever would pay for that.
This person uses the "X% of Americans" line, so they live in the United States, right? The one in North America that views healthcare as a business to wring money out of? They definitely should have done more market research if they could type that with a straight face.
But hey, hindsight is 2020 and they only spent $40k on some very valuable firsthand experience. Sounds like a win if they're planning to run businesses in the future, but for ideas without a clear path to making enough money to sustain themselves, try to use other peoples' money next time :)
The most disappointing thing in this story is that glaciermd.com doesn't even resolve anymore.
He started a business in 2017, and closed the doors in 2018. What?
Recently, I was contacted by a person who told me he saw one of my videos on YouTube about Ycombinator (it had 50 views!!!), he had to meet me in person. We met a couple days later. He was a very smart guy with an impressive resume.
He quit his job in equipment manufacturing to pursue entrepreneurship. He was a former USC student, so naturally he traveled back to California, rented a small room where him and his business partner churned on their idea. It was a sort of classified for colleges.
Not a terrible idea in anyway. He knew the college life so he must have known things I didn't. I told him he should have tested his idea before quitting his job and moving into a whole other country where he had only been a student. He showed me the website, and it was obviously made by someone who was learning React. There is no need to go fancy when you are still testing your ideas. But there was a problem.
They were paying thousands of dollars a month to keep this barely functional app running.
This is something I see a lot of young people entering web development are doing. They get beefed-up cloud services that eat up a good chunk of their money. Most people think this is the regular cost of being online. It's not! A year later, the domain name doesn't resolve either.
In the story, OP alludes living with his parents. I imagine to save money. But then there is $40k. I hope that it wasn't mostly on the AWS cost. But he gathered valuable data that did cost money.
Don't shut down the website. Keep it running and make the data available in read only mode and add a donation button (alternative to ads). It should cost $5 a month to host on linode or digitalocean. Don't let the money you spent go down the drain.
I'm so confused. Not like I'm a doctor, but doesn't the foundational assumption seem fatally flawed? How can you reduce drug efficacy to a single number? It's one thing to compare brands of the same drug, but why in the world are aspirin and acetaminophen (or whatever) just viewed like interchangeable substitutes here? I know I certainly don't reach for the strongest painkiller—but rather the weakest one that might do the job. And I know my doctors certainly never viewed these painkillers as interchangeable. Don't the natures of the effects and side effects actually matter to people?
> “And that isn’t worth something? Prescribing better treatments?”
> “Hmmmm,” she said, picking at her fingernails. “Not directly. Of course I always have the best interests of my patients in mind, but, you know, it’s not like they’ll pay more if I prescribe Lexapro instead of Zoloft. They won’t come back more often or refer more friends. So I’d sorta just be, like, donating this money if I paid you for this thing, right?”
I've never seen such a concise indictment of the American healthcare model.
If this thing works as a better search engine for medicine, then I'd want my doctor using it. Could this person have trialled it in a healthcare system with a public-option?
Convince the government your product is a benefit to their doctors and by extension their citizens, and a good government should pay you for it after a proper trial.
Instead he walked into a situation where the incentives are utterly fucked by an atomised, privatised, and consumer-oriented healthcare system.
While not a unicorn, this could potentially succeed as an indie-hacker sized project. One potential business strategy could be a high-level information hub - a weekly blog + podcast for example. Each week look at a different drug or illness, look at all the relevant papers, do a short statistical analysis, and summarize. Then get some patreons, run ads, maybe sponsorships for particular drugs, etc. I think there's a lot of math geeks out there that would find this useful/interesting enough to follow on a regular basis, even if just to see what's going on in the healthcare space.
Another idea that could make this a viable business: while in general consumers won't pay for this sort of thing, there are certain problems that the medical establishment just does a horrible job treating, where I think people would gladly pay up. Migraines, for example.
I personally suffer from some sort of headache disorder (symptoms are a mix between migraines and cluster headaches, I've had different diagnoses). I went to a neurologist every 3 months for 2 years, at $200 per 30 minute visit, and usually less than 10 of those minutes were spent with the doctor. Every time he made some seat of the pants guess as to what to do next (adjust the dosage I was receiving, or change medications). In the end, I never found anything better than taking a bunch of ibuprofen at the first sign of a headache, and that was something I figured out on my own.
I wouldn't pay a dime to see a comparison of generic and name brand NyQuil, but if a trustworthy source offered me a personalized report on what medications I should be looking at based on my headache symptoms, and had studies to back it up, I'd gladly pay $100+.
This is one of the best startup post-mortems I've read on HN. Clear and engaging writing which also provided key insights into the mind of the entrepreneur during his journey. It's sad that it didn't work out but I think it can help teach valuable lessons to anyone reading it.
It's a shame this project was shuttered as what screenshots are posted look amazing.
Better data aggregation is desperately needed in medicine and sadly I think the creator has walked face first into the horror of cost merely to access clinical trials. Plus, the cost of paying contractors to extract the actually useful information from those trials.
These are key reasons why Open Science and Open Data are so critical, to produce tools like this one. Sadly I don't think there is a "Startup" level of money available for it even so.
It is easy to be an armchair expert, but I saw that this is not a viable idea: almost nobody would pay for it, for 99% of the cases patients and doctors already know the medication that is good enough and good for them (ibuprofen for me, acetaminophen for my friend because Ibuprofen upsets her stomach etc). And remaining 1% will most likely require serious medical attention, not just rando site. Let alone the fact that this is borderline dispensing medical advice which is a highly regulated activity!
One way to look for a similar business is examine.com (disclosure: I do not use them but read their write ups and articles about them on indie hackers-like sites and podcasts). It is a site that gives information about supplements. The supplement landscape is much more wide than that of painkillers, they are hard to compare, and supplements are usually chosen by consumers themselves, and supplement information is unlikely to be treated as a medical advice.
[+] [-] amitmathew|6 years ago|reply
And here's something that's absolutely critical for all engineers trying to build a startup in healthcare to really understand. Healthcare is so alluring because tech people are so idealistic. We think, "Wow, we we can write some code, and then save lives!" And that's sometimes true. But when you are thinking of your customer, revenue model, sales strategy - all that business stuff - the mistake we make is thinking healthcare is different and the same rules don't apply. We think if we can save lives, we can make a business. But the key insight is that you have to take a step back and just treat healthcare like any other for-profit business. Doctors and hospitals care about what generates revenue. Insurance companies want to save money. Pharma companies are looking to advertise to new customers. It's no different than other industries. The psychiatrist's reaction to the sales pitch is the classic thing a doctor will tell when you're not helping their bottom line. As I was reading the post, I could almost predict how she was going to respond.
And if you figure that business stuff out, who knows, you might just build a healthcare business that saves a life or two.
[+] [-] wayoutthere|6 years ago|reply
Health insurance companies are very aware of this, which is why they so frequently deny coverage for various life-saving cancer treatments. If you die while waiting for treatment, not only do they save the cost of the treatment, but also the entire cost of ongoing screening / care during remission.
[+] [-] jimbokun|6 years ago|reply
This is one of the most concise and effective arguments I have read for Medicare-For-All, Single Payer, etc.
[+] [-] ljm|6 years ago|reply
It is truly humbling because there is no easy solution, there are no unified APIs; you couldn't use them even if there were, because your medical records are highly sensitive. So forget about poking around production to solve a bug, you've got to do it through observability.
You can't move fast and break things because your downtime will get the regulators involved, because peoples livelihoods are at stake. You will get official complaints through various official bodies who can and will sanction the business.
In short, it's not a fucking joke and it takes a lot more time and a lot more money to do something serious here, and for good reason.
Note that I'm not talking about low-key wearables like Fitbits that monitor your pulse, I'm talking about doctors, triage, etc.
[+] [-] macspoofing|6 years ago|reply
They are hard, but this case isn't really healthcare-related. He tried pitching his product to practices without showing how it could increase their revenue, or decrease their costs. Without that, his product is just another cost-center with some marginal (and ambiguous) healthcare benefits.
[+] [-] Toenex|6 years ago|reply
[+] [-] angrais|6 years ago|reply
What's the t-shirt look like? :)
[+] [-] catchmeifyoucan|6 years ago|reply
There are a few paths I see still:
a. Assuming you own a database, expose your dataset as an API. Consider possible consumers. Open source it, and monitor the usage. Who’s using that data.
b. Cold message a few folks on Linkedin from pharmaceuticals that your algo says has high clinical success. Can you “recommend” them? Do they see value. Maybe you have a research tool on your hands.
3. If you can keep your website alive, focus on SEO and gain traction with more users and play that out. Write blog posts, use affiliate marketing, and grow users. But don’t add new features. Just maintain what you have. Try that for a year at least. What did you learn?
I think the toughest thing here is knowing when to stop building the product. That’s what stands out to me as your demise.
The doctor was spot on, and those are the kinds of things you want to hear. It just means looks somewhere else. Writing a doc beforehand with potential opportunities is always a good idea, but it’s never too late.
Disclaimer: I do product at MEGACORP and love product strategy.
[+] [-] wayoutthere|6 years ago|reply
In this case, similar functionality (drug recommendations) exist within EMR systems. Except the recommendations are issued by other doctors and medical researchers, not some ML algorithm and it works transparently with the pharmacy management modules.
Moral of the story: don't get involved with healthcare startups unless you know the structure and economics of the industry. They are very different from consumer / business tech.
[+] [-] bduerst|6 years ago|reply
The only downside is that sharing this information may open up the hospital to more liability - i.e. a patient takes an opiate instead of an NSAID and then blames the hospital for recommending the opiate to them because of how much more effective the opiate is at treating pain in clinical trials.
[+] [-] nikita2206|6 years ago|reply
[+] [-] rossdavidh|6 years ago|reply
[+] [-] utopian3|6 years ago|reply
Where should one go/read/listen/watch to learn more about product strategy?
[+] [-] rconti|6 years ago|reply
[+] [-] gkoberger|6 years ago|reply
"So I built something people wanted. Consumers wanted it, doctors wanted it, I wanted it. Where did I go wrong?"
As far as I can tell, nobody wanted it except the author. The one doctor he talked to didn't, and no consumer ever saw it. I feel like the author learned a lesson, but not the full lesson.
Reading this was like watching someone you don't politically agree with doing comedy. You know they're trying to be funny, but you also know they're missing the whole point and aren't self-aware.
[+] [-] mritchie712|6 years ago|reply
I, as a consumer, find it worthless and they shouldn't have even started it, but now that you're here, might as well give it a bit more of shot than that. To completely bail on what you have after 10 no's is also the wrong move.
Doesn't seem like he asked the question, "well, what would you pay for?"
[+] [-] tootie|6 years ago|reply
[+] [-] jstrong|6 years ago|reply
are you not supposed to laugh at the jokes of someone you disagree with politically? is it possible someone could be "self-aware" and still disagree with you?
[+] [-] justingreet|6 years ago|reply
He then goes on to describe the evidence specifically why doctor's DIDN'T want it. All the author was trying to do with that quote was explain what he was thinking at the time.
[+] [-] jariel|6 years ago|reply
[+] [-] utopian3|6 years ago|reply
[+] [-] riazrizvi|6 years ago|reply
[+] [-] ping_pong|6 years ago|reply
Sure, Aleve is the most powerful. But it also has the most side effects, including ulcers if used for too long. There's a lot of nuanced information when it comes to drugs. If you want to go on pain killers like Aleve for long term, you probably need to take acid blockers as well, like Nexium. So where does that fall into the analysis?
Unfortunately a lot of stuff requires medical doctors that have experience. I just went through a severe health emergency, where I was taking one antibiotic and needed to be changed to another. I needed blood tests and constant supervision for the doctor to make this decision.
Psychiatry, which is what I guess the author targeted, is likely even less reliable. My friend is a pharmacist and was on anti-anxiety medication for a year, but decided to try another one, because of the effects on her were affecting her and now she's doing much better. This requires working with a psychiatrist for a year.
I think there's value in surfacing all this information but to expect people to rush into paying for it is naive. It's a nice-to-have-tool that might be useful like a Google-type research tool but nothing someone would want to pay $5/month for since the actual benefit over a psychiatrist just going off experience is completely unknown. There no inherent home run here.
[+] [-] astura|6 years ago|reply
Am I wrong or isn't solving these issues basically the service UpToDate offers?
[+] [-] legitster|6 years ago|reply
Especially the doctor's feedback, she described the possibility of changing her habits slowly as she got used to using the tool.
Unrelated:
"I always have the best interests of my patients in mind, but, you know, it’s not like they’ll pay more if I prescribe Lexapro instead of Zoloft. They won’t come back more often or refer more friends. So I’d sorta just be, like, donating this money if I paid you for this thing, right?”
This line kills me and it's exactly why I hate the healthcare industry. She clearly understands that the software could improve patient outcomes, but describes it as a donation and still wouldn't change how she writes prescriptions (out of laziness, I guess?)
[+] [-] gringoDan|6 years ago|reply
[+] [-] logfromblammo|6 years ago|reply
That tool isn't just a physician aid. If that's what doctors are really doing, it's more like a physician replacement. If they won't do evidence-based medicine, and prefer to be legal drug dealers, for profitability reasons, we should all be contributing to the creation of the auto-doc, instead of trying to help them.
That $40k would have been better spent lobbying to remove the guild protections from the practice of medicine.
If all general-practice docs do is take height, weight, pulse, BP, blood oxidation, and run a CBC with lipid panel before prescribing your drugs for the year, that doesn't seem like something only an MD or NP could do. But by law, if you want prescription-only medicines, you have to go to a prescription-drug dealer and pay them for the scrip, before going to pay someone else, again, for the actual drug.
And if they're not actually doing (what I perceive to be) their jobs? If they're just "phoning it in" to collect a paycheck? That's one job I'd love to automate out of existence.
[+] [-] danenania|6 years ago|reply
I think in general, if you're building a business, expecting anyone to do something that isn't in their own selfish interest in some way is a recipe for failure, even if people in your target market might claim not to have selfish motivations. If you want someone to change their behavior (and/or their organization's behavior), you need to be able to clearly explain why it's a win for that specific person.
[+] [-] Frqy3|6 years ago|reply
[+] [-] beat|6 years ago|reply
[+] [-] gbasin|6 years ago|reply
[+] [-] dahart|6 years ago|reply
A lot of comments criticizing what the author already knows, that the business plan was incomplete. I had the urge to do the same, but read to the very end and realized TJC clearly learned the most important lesson, and it's one I've learned myself, so I have no room to be critical.
BTW, I burned a lot more than $40k and 9 months in my own story, so maybe it helps to hear that other people have made the same mistake and gotten too convinced their idea is valuable without checking carefully enough -- without quite knowing how to check carefully. I know what it feels like to know that I'm doing the right thing, and then find out that it's not good enough.
Fun read, and an important lesson that many very bright people will still learn the hard way, even after reading a story like this. Thank you for sharing.
[+] [-] moneywoes|6 years ago|reply
[+] [-] uj8efdkjfdshf|6 years ago|reply
The real benefit IMO would be marketing this to countries with a top down healthcare purchasing system (eg the UK) or as a tool to drug companies/researchers looking to make their own meta analyses (eg abstrackr). It might also be better instead to diversify into correlating symptom clusters with diseases because then the utility to the end user is bigger.
[+] [-] allcentury|6 years ago|reply
Sell this product to insurance companies so they can recommend cheaper/safer drugs to their customers, or show the more expensive one and if it truly had better outcomes. Everyone benefits from that.
That said, the medical establishment is a tough tough domain to move.
[+] [-] StavrosK|6 years ago|reply
Why do people shut things down instead of just leaving them there, unmaintained? Even that is better than just taking it offline.
[+] [-] opportune|6 years ago|reply
The only way to make money is to get insurers to require these things, or to sell to some big hospital network administrator who you can focus your sales efforts on. I don’t think the product here was mature enough to sign a multimillion dollar contract with a hospital network, and maybe not for insurers either.
[+] [-] amirhirsch|6 years ago|reply
Nice narrative style and congratulations on achieving your (first?) failure without too much trauma.
It's possible you invested your own money prematurely, possibly without talking to enough people about the opportunity. Your metric for how much people want something is usually directly tied to revenue, or if you are using engagement as your metric, you should have figured out some way to make money off of it before you invested in development. I suggest that other engineering-minded founders think of sales like writing "hello world" -- for example, if you're doing a physical consumer product, you can start by shipping pet rocks on day one.
More than just identifying a product people want, you also want to find a network effect or viral marketing approach so you can grow with a sustainable advantage.
[+] [-] whiddershins|6 years ago|reply
The startup idea sounds great and I would enthusiastically start working on it right now as a cofounder.
The problem was spending money before having a sense of how to get more.
That’s all.
If the startup could have been run entirely without paying contractors or incurring other serious expenses, the poster could have run it for longer, and iterated on models longer, until the product/market fit got dialed in.
There just wasn’t enough runway, enough iteration.
[+] [-] leggomylibro|6 years ago|reply
>It had been a bit of a working assumption of mine over the past few weeks that if you could improve the health of the patients then, you know, the doctors or the hospitals or whatever would pay for that.
This person uses the "X% of Americans" line, so they live in the United States, right? The one in North America that views healthcare as a business to wring money out of? They definitely should have done more market research if they could type that with a straight face.
But hey, hindsight is 2020 and they only spent $40k on some very valuable firsthand experience. Sounds like a win if they're planning to run businesses in the future, but for ideas without a clear path to making enough money to sustain themselves, try to use other peoples' money next time :)
[+] [-] ibudiallo|6 years ago|reply
He started a business in 2017, and closed the doors in 2018. What?
Recently, I was contacted by a person who told me he saw one of my videos on YouTube about Ycombinator (it had 50 views!!!), he had to meet me in person. We met a couple days later. He was a very smart guy with an impressive resume.
He quit his job in equipment manufacturing to pursue entrepreneurship. He was a former USC student, so naturally he traveled back to California, rented a small room where him and his business partner churned on their idea. It was a sort of classified for colleges.
Not a terrible idea in anyway. He knew the college life so he must have known things I didn't. I told him he should have tested his idea before quitting his job and moving into a whole other country where he had only been a student. He showed me the website, and it was obviously made by someone who was learning React. There is no need to go fancy when you are still testing your ideas. But there was a problem.
They were paying thousands of dollars a month to keep this barely functional app running.
This is something I see a lot of young people entering web development are doing. They get beefed-up cloud services that eat up a good chunk of their money. Most people think this is the regular cost of being online. It's not! A year later, the domain name doesn't resolve either.
In the story, OP alludes living with his parents. I imagine to save money. But then there is $40k. I hope that it wasn't mostly on the AWS cost. But he gathered valuable data that did cost money.
Don't shut down the website. Keep it running and make the data available in read only mode and add a donation button (alternative to ads). It should cost $5 a month to host on linode or digitalocean. Don't let the money you spent go down the drain.
[+] [-] mehrdadn|6 years ago|reply
[+] [-] _bxg1|6 years ago|reply
> “Hmmmm,” she said, picking at her fingernails. “Not directly. Of course I always have the best interests of my patients in mind, but, you know, it’s not like they’ll pay more if I prescribe Lexapro instead of Zoloft. They won’t come back more often or refer more friends. So I’d sorta just be, like, donating this money if I paid you for this thing, right?”
I've never seen such a concise indictment of the American healthcare model.
[+] [-] thundergolfer|6 years ago|reply
Convince the government your product is a benefit to their doctors and by extension their citizens, and a good government should pay you for it after a proper trial.
Instead he walked into a situation where the incentives are utterly fucked by an atomised, privatised, and consumer-oriented healthcare system.
[+] [-] scottmsul|6 years ago|reply
[+] [-] mrfredward|6 years ago|reply
I personally suffer from some sort of headache disorder (symptoms are a mix between migraines and cluster headaches, I've had different diagnoses). I went to a neurologist every 3 months for 2 years, at $200 per 30 minute visit, and usually less than 10 of those minutes were spent with the doctor. Every time he made some seat of the pants guess as to what to do next (adjust the dosage I was receiving, or change medications). In the end, I never found anything better than taking a bunch of ibuprofen at the first sign of a headache, and that was something I figured out on my own.
I wouldn't pay a dime to see a comparison of generic and name brand NyQuil, but if a trustworthy source offered me a personalized report on what medications I should be looking at based on my headache symptoms, and had studies to back it up, I'd gladly pay $100+.
[+] [-] rmah|6 years ago|reply
[+] [-] elliotpage|6 years ago|reply
Better data aggregation is desperately needed in medicine and sadly I think the creator has walked face first into the horror of cost merely to access clinical trials. Plus, the cost of paying contractors to extract the actually useful information from those trials.
These are key reasons why Open Science and Open Data are so critical, to produce tools like this one. Sadly I don't think there is a "Startup" level of money available for it even so.
[+] [-] mynegation|6 years ago|reply
One way to look for a similar business is examine.com (disclosure: I do not use them but read their write ups and articles about them on indie hackers-like sites and podcasts). It is a site that gives information about supplements. The supplement landscape is much more wide than that of painkillers, they are hard to compare, and supplements are usually chosen by consumers themselves, and supplement information is unlikely to be treated as a medical advice.
[+] [-] iabacu|6 years ago|reply
At their scale, they can use the data to drive their costs down, and can build a business case for paying you something.